Treatment of Liver Cancer
Treatment of primary liver cancer is challenging when compared with other types of cancer because in addition to the cancer itself, many patients have livers that have been damaged by chronic hepatitis B infections.
For each individual patient, the potential benefits of the various treatment options must be balanced with the risk of liver failure and how it affects the patient's quality of life. The most common treatment options are described below. A liver transplant is the only treatment option for those with liver cancer tumors that cannot be surgically or medically removed.
Surgical removal of small tumors is the treatment of choice for primary liver cancer in patients who do not have cirrhosis, which is approximately 5% of the cases in Western countries, and about 40% in Asia. In patients who have cirrhosis, however, resection may cause liver failure with increased risk of death. The 5-year survival today after resection can be more than 50% as patients are being identified at an earlier stage of liver cancer, surgical techniques continue to improve, and doctors are better able to identify the best candidates for resection.
Ablation is the best treatment option for patients with early-stage liver cancer who cannot undergo surgery or transplantation. In ablation, the tumor cells are destroyed by injection of chemical substances or by changing the temperature inside the liver with the use of radiofrequency, microwave, laser, or cryotherapy.
Ethanol injection is very effective for small liver tumors smaller than 2 cm, has a low rate of side effects, and is inexpensive. The procedure, however, requires repeated injections on separate days and does not completely destroy tumors larger than 3 cm, because the injected ethanol cannot access the entire tumor volume.
Radiofrequency ablation is a type of heat therapy and has better results for larger tumors in fewer treatment sessions, but it is more expensive than ethanol injection and causes more side effects, such as build-up of fluid around the lungs or abdominal bleeding.
Other types of heat therapies that destroy liver tumors include laser or microwave therapy. These therapies are used less often than radiofrequency ablation.
Transarterial Embolization or Chemoembolization
Transarterial embolization (TAE) or transarterial chemoembolization (TACE) work by blocking the hepatic artery, which is a large blood vessel that serves the liver. In liver cancer, the hepatic artery provides the blood supply to the growing tumor. One way to stop the tumorís growth is to block its blood supply. With TAE, the hepatic artery is blocked using a specialized X-ray technique called angiography. In TACE, chemicals are injected into the hepatic artery before the TAE procedure.
TAE and TACE are considered for patients with liver cancer who cannot undergo surgery or percutaneous ablation. TAE and TACE should not be used in patients in whom the liver cancer has spread, or in those who have blockage of the hepatic vein. These procedures also should not be used in patients with advanced or end-stage liver cancer, because these individuals have an increased risk of liver failure or death.
Long-term treatments with TACE or TAC have been associated with prolonged patient survival, and those who have good control or shrinkage of the tumor may even become suitable candidates for surgery or transplantation.
Traditional chemotherapy for liver cancer has had minimal anti-tumor activity and no impact on survival. Researchers are now developing new types of chemotherapy that target certain protein messengers that are involved in the growth and spread of cancer cells. One such targeted therapy called Nexavar is the first approved oral drug in the United States and other countries. It can be used to treat patients with primary liver cancer whose tumors cannot be removed with surgery. Nexavar, which is taken by mouth, blocks the tumor cells from growing and dividing and reduces the formation of blood vessels that supply the tumor cells.
Radiation therapy may be an option for some patients who cannot have surgery. Radiation therapy may be used with other treatment approaches and to help reduce pain from liver cancer that has spread to the bones. Doctors use two types of radiation therapy to treat liver cancer:
- External radiation therapy which aims radiation at the patientís chest and abdomen.
- Internal radiation therapy comes from tiny radioactive spheres that a doctor injects into the patientís hepatic artery using a catheter. The spheres then destroy the blood supply to the liver tumor.
A liver transplant is the only treatment option for patients with liver cancer tumors that cannot be surgically or medically removed. And the cancer cannot have spread outside the liver or into the blood vessels.
There are two types of liver transplants:
- Orthotopic liver transplantation refers to a procedure in which a new healthy liver is transplanted into a person with liver cancer and/or whose liver has failed. In this case, the liver donor is someone who has recently died. The procedure is the most common method used to transplant livers.
- Living donor transplantation refers to a healthy, living personís donation of part of his or her liver to someone who needs a new liver. This procedure has been increasingly successful and shows promise as a solution to the shortage of liver donors.
When a new liver from a deceased or living donor becomes available, the transplant surgeon removes the patientís old liver and replaces it with the new donated liver. After surgery, a patient may need to stay in the hospital for several weeks. During that time, they will take medicine to prevent the body's immune system from rejecting the new liver.
The first 3 months after transplantation is when the patient requires the most medication. After that time, some medicines can be stopped or their dosages decreased. Some of the medication is dosed according to the patient's weight. It is important for the patient to be familiar with the medications. It is also important to note their side effects and to understand that they may not occur with everyone. The side effects may lessen or disappear as the doses of medicine are lowered over time. Not every patient having a liver transplant takes the same medications.
Additional Information About Liver Cancer Treatments
Visit Liver Cancer Connect, the Hepatitis B Foundation's dedicated patient-focused liver cancer website.